Operating room discharge after deep neuromuscular block reversed with sugammadex compared with shallow block reversed with neostigmine: a randomized controlled trial

Putz, Laurie; Dransart, Christophe; Jamart, Jacques; Marotta, Maria-Laura; Delnooz, Geraldine; Dubois, Philippe

doi:10.1016/j.jclinane.2016.07.030

Cited by 25 publications

(25 citation statements)

References 33 publications

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“…A number of prior studies have demonstrated that sugammadex induces rapid reversal of neuromuscular blockade, resulting in more rapid extubation and operating room discharge [8,12,16,19,20,21,22]. The postoperative effects of sugammadex following patient discharge from the operating room, however, have been mixed, with some studies reporting faster PACU discharge times [8,10,11], and others reporting no difference [8,17,23,24]. PACU discharge time may be affected by several factors such as bed availability in the ward, physician release, nurses’ decisions, additional test like radiographs, and availability of transport team [25].…”

Section: Discussionmentioning

confidence: 99%

“…Even in the context of a deep neuromuscular block, sugammadex achieves rapid, complete, and reliable reversal. Putz et al [8] compared deep neuromuscular block reversal with sugammadex, and shallow neuromuscular block reversal with an acetylcholinesterase inhibitor, and found faster and more reliable reversal rates with sugammadex in abdominal surgery patients [8]. This suggests that sugammadex provides faster recovery than acetylcholinesterase inhibitors, regardless of rocuronium dosage or level of neuromuscular block.…”

Section: Introductionmentioning

confidence: 99%

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Thirty-Day Postoperative Outcomes Following Sugammadex Use in Colorectal Surgery Patients: Retrospective Study

Chae

Joe

et al. 2019

JCM

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Purpose: Sugammadex rapidly reverses muscle relaxation compared to acetylcholinesterase inhibitors. The long-term outcomes of sugammadex, however, are not well known. We compared 30-day postoperative outcomes following sugammadex and acetylcholinesterase inhibitor use in colorectal surgery patients. Patients and methods: Colorectal surgical patients older than 21 were included in this retrospective study, and were dichotomized according to use of reversal agents, sugammadex (group S), and acetylcholinesterase inhibitor (group A). We assessed 30-day postoperative outcomes, including total length of hospital stay, length of postoperative hospital stay, readmission rate, and delayed discharge rate. Additional parameters included postanesthetic care unit stay time, time to first successful oral intake, unforeseen intensive care unit (ICU) admission rate, postoperative pulmonary complications, and mortality. Results: Among a total of 585 patients, 157 patients remained in each group after propensity score matching. Total length of hospital stay, length of postoperative hospital stay, and readmission rates did not differ between the two groups, while the incidence of delayed discharge was significantly lower in group S (23 (15%) vs. 40 (25%), p = 0.017). Other outcomes did not differ between the two groups. Conclusion: We found no difference in 30-day postoperative outcomes following sugammadex and acetylcholinesterase inhibitor use. The only difference between these treatments was the associated incidence of delayed discharge, which was lower in group S.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Thirty-Day Postoperative Outcomes Following Sugammadex Use in Colorectal Surgery Patients: Retrospective Study

Chae

Joe

et al. 2019

JCM

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“…[15] This mechanism is ultimately both faster and more specific than neostigmine. [19][20][21] This potentially can yield cost savings in the operative setting.…”

Section: Discussionmentioning

confidence: 99%

Sugammadex administration shortens reversal times but not operating room turnover times

Enten¹,

Albrink

Deng

et al. 2019

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Objective: Current literature debates whether administration of sugammadex translates into a higher operating room (OR) efficiency when compared to neostigmine. This study is a blinded assessment of the effects of sugammadex versus neostigmine on OR efficiency as determined by time of reversal to time of the next case.Methods: 50 patients undergoing abdominal surgery were randomized and evenly distributed into two groups, one receiving sugammadex (4 mg/kg) and the other, neostigmine (0.06 mg/kg) plus glycopyrrolate (0.004 mg/kg). Muscle paralysis was induced with intravenous rocuronium (0.6 mg/kg). Train of four (TOF) was monitored using acceleromyography every 10 minutes until reversal. Reversal agents were blindly prepared and administered during closing. TOF was then recorded every minute until a T4/T1 ratio ≥ 0.9 was achieved. This was designated as time of complete reversal. Subsequently, post-reversal outcome measures were collected.Results: Patients receiving sugammadex experienced a significantly shorter reversal time compared to those receiving neostigmine and glycopyrrolate (2.92 ± 1.71 minutes vs. 7.68 ± 5.63 minutes; p = .0002). No other outcome measures were significantly different between groups: time of OR ready for next case was 55.4 min vs. 56.1 min respectively; not significant.Conclusions: While sugammadex was significantly faster at reversing patient neuromuscular blockade the time from reversal to patient extubation after Sugammadex was prolonged. . This could be due to blinding, as blinded providers are unable to anticipate time of reversal and must compensate by making decisions at safe fixed intervals. This is reflected in that the time gained by administration of sugammadex is approximately equal to the delay experienced across all endpoints collected to the patients’ actual discharge.

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“…On the other hand, every minute of open operating theater time has a high financial value [102]. A few minutes spared with a faster and more predictable reversal strategy allowing for a shorter operating room discharge can balance the cost of the new drug and contribute to optimization of operating theater turnover and overall financial return [103].…”

Section: Pharmacological Reversal Of the Residual Nmbmentioning

confidence: 99%

Deep Neuromuscular Blockade Improves Surgical Conditions During Gynecological Laparoscopy

Dransart¹,

Putz²,

Marotta³

et al. 2017

Fertility-Oriented Female Reproductive Surgery

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Obtaining an appropriate laparoscopic workspace depends on several factors related to the patient (i.e., weight and abdominal compliance) and the procedure (i.e., body's position, depth of anesthesia and intra-abdominal (IA) pressure). Among them, a deep neuromuscular blockade (NMB) contributes to provide the surgeon with better operating conditions. This chapter discusses the interests and challenges of muscle relaxation during gynecological laparoscopy. The introduction of sugammadex into clinical practice provides the opportunity to modify the management of neuromuscular blockade to improve the surgical conditions during laparoscopy as well as the safety of the patients. The maintenance of a rocuronium-induced deep neuromuscular block from the trocar insertion until the end of laparoscopy is no longer incompatible with rapid recovery and awakening in optimal conditions. Neuromuscular transmission (NMT) monitoring is the key to adequate management and should be used in all cases. Objective measurements allow for excellent intubation and surgical conditions, the definition of thresholds and doses for the administration of reversal agents, and the exclusion of residual blockade prior to the patient extubation.

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Operating room discharge after deep neuromuscular block reversed with sugammadex compared with shallow block reversed with neostigmine: a randomized controlled trial

Cited by 25 publications

References 33 publications

Thirty-Day Postoperative Outcomes Following Sugammadex Use in Colorectal Surgery Patients: Retrospective Study

Thirty-Day Postoperative Outcomes Following Sugammadex Use in Colorectal Surgery Patients: Retrospective Study

Sugammadex administration shortens reversal times but not operating room turnover times

Deep Neuromuscular Blockade Improves Surgical Conditions During Gynecological Laparoscopy

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